The Evolution of Caffeine in Neonatal Intensive Care
Caffeine citrate has long been recognized as a cornerstone of neonatal pharmacology. Since the landmark Caffeine for Apnea of Prematurity (CAP) trial in 2006, methylxanthines—specifically caffeine—have transitioned from being a targeted treatment for apnea to a foundational therapy for improving respiratory outcomes in very low birth weight infants. Despite its widespread use, the neonatal community continues to grapple with the “when” and “why” of caffeine initiation. The 2025 Cochrane systematic review by Borys and colleagues provides a timely and rigorous evaluation of the relative benefits and harms associated with different timings and clinical indications for starting this essential medication.
